Facility Evaluation Report

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of completing an annual inspection. Upon arrival LPA was greeted and granted entry by the facility staff. At the time of LPA arrival Administrator (AD) was not present. Administrator was made aware of LPA arrival via telephone and arrived shortly after to assist LPA with the annual inspection. LPA began a tour of the facility and observed the following. AD has a valid Administrator certificate valid from June 8, 2025 through June 7,2027.

The facility is a one storied home equipped with four bedrooms three of which are utilized for residents in care and one of which is for staff use. The facility is equipped with two and a half bathrooms one of which is shared and another one of which is utilized for staff use only. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed kitchen area to be equipped with a gas stove, refrigerator, dishwasher, and a microwave all appeared to be in good condition and tested operational. LPA observed the facility to have a two day supply of perishable food and a seven day supply of non-perishable food on hand. Additionally LPA observed a sufficient amount of emergency water on hand.

LPA observed all resident bedrooms to be large enough to walk about freely, additional bedrooms are large enough to accommodate all required furnishings; LPA observed all bedrooms to be equipped with all furnishings including a chest of drawers, a reading lamp, a chair, a bed, clean linens in good repair; meaning no strains or tears, and a sufficient amount of storage space to store personal belongings. LPA observed all restrooms to be clean and free of any mildew and debris. Restrooms have all required furnishings including a shower chair, grab bars, and slip resistant floor matts. Hot water temperature tested between 119.2 and 120.0 Degrees Fahrenheit. CONTINUED ON LIC809-C